Counting the Uninsured: 46 Million or “More than 30 Million”?

Last night, President Obama stated: "We are the only democracy—the only advanced democracy on Earth—the only wealthy nation—that allows such hardship for millions of its people. There are now more than 30 million American citizens who cannot get coverage."

Today, the Bureau of the Census released the most recent data on the number of uninsured Americans. The report, Income, Poverty, and Health Insurance Coverage in the United States: 2008, reveals that 46 million people were uninsured in 2008, the last year for which there are data. These data are based on the Current Population Survey. With two different numbers, there has been some confusion as to which is accurate. Well, both are -- and the President's version is more focused on the relevant target population for health reform since it excludes unauthorized immigrants.

The Census report indicates that of the 46 million uninsured individuals, 34 million were native born and 2.8 million were naturalized citizens. The report thus shows that there were 36.8 million uninsured U.S. citizens (native born and naturalized) in 2008. An alternative calculation includes legal immigrants, which based on a figure from the Pew Hispanic Center would bring the total to something like 39 million.

Some ambiguity surrounds how to treat individuals who are already eligible for public insurance programs like Medicaid and S-CHIP but do not enroll in those programs, which estimates from the Kaiser Commission on Medicaid and the Uninsured suggest may amount to millions of individuals. These individuals are uninsured but some interpretations would suggest they should not be counted among those who "cannot get" coverage. Subtracting them from the total would produce a number closer to 30 million.

To be conservative, the President thus stated that "more than 30 million American citizens" cannot get coverage.